ManymedicalstudentsofmygenerationwereattractedhematologycareerbecauseofitsintimateconnectiondiscoveryGreatrolemodelhematologiststookusthemicroscopediscoverthecauseofthediseaseaffectingourpatientsando ID: 959786
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heHematologistDiscovererBarryColler,David Rockefeller Professor edicineandhysicianChief,Rockefeller University Hospital Manymedicalstudentsofmygenerationwereattractedhematologycareerbecauseofitsintimateconnectiondiscovery.Greatrolemodelhematologiststookusthemicroscopediscoverthecauseofthediseaseaffectingourpatientsandopenedoureyesnewworldwhichcarefulanalysisofcellsize,shape,andcolorcouldnotonlylead numberofthingsoverthepastyearshaveerodedthemodelofthephysiciandiscoverer,including:Theunfortunatedenigrationofobservationalscience researchcanbe“outsourced.”Theincreasingacceptanceoftheinsidiousnotionthatphysiciansonlyneedknowsciencethattheycanapplytheirpatientsratherthanneedingknowbecausetheyhaveprofessionalobligationcontributemedicalknowledge.Theimpactofeducationaldebtonclinicianswhowouldlikeparticipatediscoveryandthetimeandadministrativedemandsofcurrentmedicalbusinessmodels. Oneofthechallengessustainingthephysiciandiscoverermodeltheneedforindividualsbecomfortablewhiletogglingbetweenthecultureofclinicalmedicineandthatofscientificdiscovery.Ashavepreviouslynoted,1,2therefundamentalculturaldifferencesbetweenclinicalmedicineandbasicscience Thetaskbeforeusnotpineforsomepasttimethatwehaveundoubtedlyromanticized,butrathermaximizetheadvantagesconferredbythenewopportunities availableustodaybestcapturethepositivefeaturesofthepast.suggestthefollowingideasexcitenewgenerationofphysiciandiscoverersexperiencethesatisfactionandsheerjoythataccompaniesbeingthefirstpersontheworldknowsomethingthathasthepowerheal. DefinethephysiciandiscovererthegoalofmedicaleducationandaddthisclausetheHippocraticOath:“Iwillmakecarefulobservationsaboutmypatientsandsharemydiscoverieswithmycolleaguesthatpatientswillbenefit.”Thecommitmentdiscoveryshouldbemade onthefirst dayofmedical schoolformallychargingtheincomingclassofmedicalstudentsdevelopfouryearlongprojectwhichtheydefinegapourunderstandingofmedicaleducationandthen,withtheassistanceofseniorfacultymembers,designandconductrandomizedstudyonthemselvestesttheirhypothesis.Theresultsshouldbeseengiftfuturemedicalschoolclassesand,morebroadly,medicalstudentseverywhere.Build“wetlab”experiencesintomedicalschoolhematologypathophysiologycourses,emphasizinghowbloodsmearsandbonemarrowsamplesarepreparedandanalyzedandhowhematologyandbloodbanklaboratorytestsareperformed.Hematology/pathologyconferencesespeciallyvaluablewhenslidesreviewedjointlybecausetheyprovideopportunityforsharingthoughtsacrossdisciplinesandforgeneratingsparksofideasforfurtherevaluation.Reunitetheclinicalspecialtieswithpathologybyrenewedemphasisonteachingclinicalandanatomicalpathology,jointclinicpathologic andpatientmanagementconferences,reciprocaltraineerotations,andfacilitatedacce
ssformedicalstudents,housestaff,andfellowstheclinicalpathologylaboratories.Helpstudentsandhousestaffsharetheinitialdiscoveryofdisordersaffectingtheirpatientsandrecognizethepowerandbeautyofanalyzingbloodcellmorphologybyencouragingthemreviewbloodsmearsandbonemarrowspecimensdayornightwithhematologyfellows,faculty,and/ortechnicianscommittedteaching.have,forexample,reviewedbloodsmearswithinternalmedicinestudentsandresidentsformanyyearsMountinaischoolofMedicineformatwhichhavecreateclinicalscenarioexplainthemorphologywithoutknowinganything aboutthepatient’shistory,physical,orlaboratoryfindings.Thisexercisefollowedbycomparingthescenariotheactualhistory,followedbymoregeneraldiscussionofpathophysiologyandpatient management.MaketheFDApackageinsertsforlaboratorytestsbeingconductedtheclinicalpathologyavailableelectronicallythehospitalstaff,includingtheprincipleoftheassay,theinstrumentation,interferingsubstances,commonartifacts,andpopulationbasednormalvalues.usethenewtoolsofsocialmediaempowerevery hematologisttheunitedstatesparticipate discoverybycreatingwebsitetitled“N=1”whichmemberscanuploadinterestingcasereport andothermemberscanaddtheircommentsonthecase,includingsuggestionsforresearchfollowupandoffersvolunteerconductadditionalstudies.encourageASmembersaddothercreativeideasthislist. hopethatsomeorofthesesuggestionswillhelplighttheflameofdiscoverynewgenerationof medicalstudentsandtraineeswhocomeseetheintellectualexcitementandbeautyhematologyandthegreatopportunitycontributethehealthof patientstodayandthefuture.able.ComparisonomeCulturalaspectsClinicaledicineandBasicscienceinvestigation Clinical m edicine Basic s cience Timely action required regar dless of certainty Reserve judgment until all evidence is compelling Focus on that which is unique Focus on the reproducible and generalizable Many uncontrolled variables All variables identified and controlled Follow practice guidelines and standard of care Be bold and take risks Error may imperil someone’s life and create Error is expected and valuable in framing new Physicians apply new knowledge Scientists discover new knowledge Provide care to a steady flow of patients Need to generate new ideas Respect for expert opinion Suspicion of expert opinion Oath No oath Suit and tie Jeans and T - shirt 1. Coller,Bs.TranslationalResearchandthePhysiciancientist.TheVanishingPhysiciancientist?Andrewchafer,editor.CornellniversityPress,2009,pps.2. Coller,Bs.Translationalresearch:forgingnewculturalidentity.inaiMed.2008;75:478487.